The Presidential Election in 2024 might hinge on the present health care crisis, but none of the candidates have been able to propose any solutions.

The band-aid since the last Democratic Administration (2016) has been three increases in the "temporary" health care surtax on households with incomes over $200,000 per year. The marginal tax rate on these households has reached 90 per cent. There is symmetry here as this group now provides 90 per cent of tax revenue, up from 35 per cent twenty years ago. I.R.S. officials are at a loss to explain why the incomes of these taxpayers have been declining in recent years. Mandatory health premiums for all Americans-including those who have opted out-have therefore increased 30 per cent each year.

The chief problem remains costs. These flattened out briefly in 2017 and 2018 when means testing was introduced and those with incomes of $80,000 or more were removed from both Medicare and all government health insurance programs. Rapid increases in cost resumed by 2019.

The crisis accelerated after the nationwide, 8-month walkout by the American Federation of Nurses and Health Care Workers in late 2019. The parallel strike by the larger Hospital Accounting Workers Union resulted in a doubling of health care payroll costs. (Both unions won an exemption from the income ceiling for eligibility for government health insurance.) Public reaction swept the Republicans back into the White House in the 2020 elections. President Bush has not yet been successful in passing her cost control legislation. An attempt was made with the creation of the National Waiting List Data Base to increase the efficiency of establishing rationing for surgery and special treatments. This was defeated when Bush refused to exempt certain "politically correct" diseases. The pleas to address the crisis of increasing death rates from delayed treatment of heart conditions went unheeded. A compromise bill eliminating all benefits for smokers was passed.

Americans are still free to opt out of the National Health Equality Plan. But since government physicians were exempted from liability, the average liability insurance premium for the few remaining private care givers has risen to $600,000 per year for physicians and $4,000,000 per year for surgeons. Private health care is therefore an option only for extremely wealthy patients-mainly from Europe and Asia. Litigation has dried up to the point that, in desperation, the National Trial Lawyers Association is now lobbying for the complete elimination of government health care in favor of unrestricted laissez-faire medicine. This has precipitated the greatest internal struggle in the Democratic Party since the Vietnam War.

One bright spot has been the relatively modest increase in the cost of prescription drugs since the failure of six of the top ten American pharmaceutical companies. Europe and China now manufacture 90 per cent of our prescription drugs. Since patents of American drug companies were eliminated, foreign companies have dominated the market. They were only held up by the need to wait for American companies to first pay the high cost of obtaining FDA approval for each new drug. The rapid decline in the introduction of more expensive and revolutionary new drugs has helped. On the down side is the explosion in the cost of vitamins since the FDA began regulating them. A federal court recently ruled that the "right to health care" requires new drugs (whose rare components are very expensive to produce) to be provided to extend the sex lives of those more than 100 years old-a bad sign for cost control in the future.

President Bush maintains that her goal is to "save" the system. Her opponent runs against his own Democrat platform. He caused a major disruption during his acceptance speech when he said "We must face up to the fact that the federal government has failed to deliver adequate health care to the poor, even at the cost of destroying it for everyone else." Neither candidate has yet provided specific remedies.

You can't figure out whom to vote for? You can't figure out how the hell we got into this situation? You might want to look back at a few previous elections.